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This is a new short form IRS document designed to simplify tax filing for anyone making up to $200,000 a year. The U.S. Government understands your needs and provides you with this short form in an effort to save your time (ensure increased compliance).

3. Date and place of birth (attach original copy of birth certificate – will be returned to you if we can find you.) ________________

4. Present sexual preference ________________

5. Social Security and/or Identity number ________________

I swear that the information above is current and true. Should discrepances be found, I agree to be penalized to the full extent of all federal systems including the IRS and/or DHS, FBI, CIA, NEA, DEA, NSA etc.

Signature ____________________________

Witness if mark is used to sign:

I_________________ testify this is the mark of the above named person and agree to all penalties should the above information be found untruthful.